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The Benefits and Barriers to Patient-directed Care

Kenneth A. Fisher (MD)
The Benefits and Barriers to...

Excerpted (pp. 126-128) from, Understanding Healthcare: A Historical Perspective, by Kenneth A. Fisher, M.D.  (

Proving that markets do work in healthcare in this country is the spectacular growth of health savings accounts along with high deductible insurance. With these accounts patients use tax-free dollars for their routine healthcare needs as they shop for the best value, using their insurance only for big-ticket items.

Instead for a vast majority of Americans with our present price- fixed, pre-paid, government dominated, third party healthcare system we have:

1) perverse incentives that encourage excess treatments that plague our system, especially Medicare

2) excessive costs

3) inferior service

4) a mistake-prone system

5) no incentives to control costs and increase efficiency

6) neglecting other critical societal needs

7) extreme complexity

8) many left with no or inadequate insurance.

Change to mostly patient directed care will be difficult for many to accept.  The Congress has been at the center of health care for over 50 years giving their members relevance, various talking points, the center of a great deal of lobbying activity and access to considerable campaign financing.  Other major players such as health insurance companies, the pharmaceutical industry and “certified” electronic health record providers have been extremely successful lobbying for great economic advantage in this government centered, price-controlled system.  Established physician organizations have become convinced that our government is the source of physician income and thus tout the government line.  The academic “experts” who testify before Congress have built their careers becoming well versed in the intricacies of our convoluted government controlled system.  All these entities will find it difficult to change to a patient-centered health care system regardless of its logic, better care and less cost.

It is in the interest of our society for each member to be as healthy and productive as possible.  This can happen only if every citizen has the possibility of having excellent up-to-the-minute health care—and the cornerstone of such care is an active therapeutic relationship with a skillful, knowledgeable, compassionate physician. Our task is to create a system whereby every American has an equal opportunity to have this type of healing relationship, thereby maximizing health while at the same time conserving resources.

We could have a healthcare system that offers equal and better care for all, as opposed to the present multi-tiered entity, with all of its attendant problems.

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